Thank you for sharing your complete experience! I am scheduled to have a Symfony Multifocal Toric implant (no cataracts) next month, and it's comforting to read a positive review, to contrast all the nightmare stories out there.
yes thanks for the information and best of luck
I just returned from a post op follow up visit with my surgeon. It looks like vision has stabilized in both lenses, but if anything changes I will certainly post .
Once again I have Bausch & Lomb Akreos in my left eye and a Tecnis Symfony in my Right eye.
Overall I'm very happy with both lenses. Even with one eye implanted with symfony I can read without issue. I've only used reading glasses once in the last few weeks and that was in a very dimly lit room reading small grey print against a green background.
My assessment so far:
Distance vision:
Very pleased with the results as both eyes measure 20/15. However, the Akreos eye appears to see far distant objects more clearly and the doctor thinks it's because of the better contrast sensitivity of that lens. Words on distant street signs for example, are clear in both eyes, but the letters tend to "pop" more with the Akreos eye
Contrast Sensitivity:
Akreos is excellent and symfony is very, very good. Viewing color spectrum charts on my HD screen, both are very similar but akreos sees just slightly more distinction on the lower end of the spectrum. In real world viewing, akreas sees distinction between greys and browns better when looking at trees and brush in the distance. Normal everyday viewing there really are no discernible differences. I'm actually going out of my way to determine differences and with both eyes open and images combined- vision is excellent.
Glare/Halos:
No Issues with Akreos. Symfony lens is still a distraction at night under certain conditions but it's slowly improving as weeks go by and in some situations not a distraction at all when it previously had been.
Colors:
Both eyes see colors exactly the same. Originally the akreos eye saw blue slightly lighter in color, but now they are both the same. Very pleased with the rich, vibrant colors both these lenses allow me to see.
Dark room conditions:
By dark room I'm talking about a room with no lights on at night with perhaps only external moonlight shining through a window or ambient light from an adjacent room. The Akreos eye sees better under these conditions. I suspect this is a result of the improved contrast sensitivity. The symfony eye tends to wash out objects especially on the periphery where akreos can see things like edges of furniture or clothes hanging in a closet a bit more clearly.
Night Driving:
I've driven under multiple conditions at night and aside from the aforementioned halo/haze with symfony, both eyes perform very well under these conditions with akreos more closely approximating my natural lens.
Had my 2nd eye done a couple of days back with an B&L Akreos lens. To Recap: I used symfony in my dominant eye and akreos in my non-dominant. I decided to go with the Akreos for the 2nd eye because of distracting halos and glare with the symfony at night. There was a chance I could have neuro-adapted with a 2nd symfony, but I was unwilling to take that chance because I do a good deal of night driving.
My observations so far between the two lenses:
Distance vision:
Akreos is sharper than Symfony. No question about it. Symfony is very good and compared to my good eye wearing a contact lens it was better than that, but now that I have both eyes using an IOL, and can compare side by side- the Akreos exceeds symfony for clarity in distance vision.
Intermediate/Near:
Symfony is much better. Near vision is very blurry with Akreos as I expected since it's monofocal set for distance. My tv (about 12 feet away from me) is clear with both eyes. The news ticker on the bottom of the screen is readable with both lenses, though slightly clearer with my symfony. My initial concern with choosing monofocal was that anything within 20 feet would be blurry. For me that is not the case. Some real world examples. There is a can of Pepsi on the table across from me about 10 feet away. The symfony eye can read 'pepsi' very clearly. The akreos also can read it though it's ever so slightly blurry. A golf ball at my feet (I'm 6'4" BTW) - the symfony eye can read the Callaway print without issue, and the akreos sees it as blurry (but can still read it), and the ball itself is fine. Both eyes open the ball looks fine and the images blend perfectly.
Contrast Sensitivity:
Akreos is excellent and noticeably better than symfony. The symfony took several weeks for contrast sensitivity to improve to where it is now and was always a bit less than my natural eye. The akreos- 2 days in - is very similar to my natural lens.
Glare/Halos:
No Issues with Akreos. Much better than symfony with headlights and street lamps at night.
Colors:
Both eyes see colors the same with the exception of blue. The akreos eye see blue slightly lighter in color. Very pleased with both lenses in this regard
My opinion:
If you don't mind wearing reading glasses get the akreos.
It's typically covered fully by insurance and it provides (at least to me) overall sharper vision with improved contrast sensitivity and no night time halos/glare. The symfony is very good too in terms of distance, but akreos is sharper.
If you want to avoid glasses and don't mind the $2500 per lens, I would suggest getting a symfony in at least your dominant eye. You will be able to see distance very well to excellent, and have the added benefit of intermediate and near vision being quite good. However, I would wait at least a month before getting the 2nd eye done to make sure you don't have issues with halos or glare at night as I did. If you don't have any issues, and cost is not a concern, then having two symfony lenses working together will make it much easier to read smaller print. If I didn't have the glare issues at night while driving I would have gladly gone with another symfony - even if it meant a slight sacrifice in distance clarity and contrast sensitivity.
If you do have issues with glare/halos then get the non-dominant eye as a monofocal. That is my current setup and i'm able to see perfectly for distance. My car's dashboard and gps screen/backup camera screen is very clear through my symfony eye and I'm able to read my phone and computer screen without reading glasses. Although I have not experienced eye fatigue, my doctor said with my current setup.long periods of reading may require reading glasses to avoid fatigue . I'm at a computer 6+ hours a day and so far so good reading without glasses.
Good luck to everyone considering these decisions as it's not easy as there is no one size fits all. Best advice is find a doctor who does a good number of these procedures across a diverse population of patients. My doctor was fantastic and explained all the risks and benefits to all options.
Thanks also to Dr. Hagan and SoftwarDeveloper for all their contributions. It's great to have a community where so many can contribute and provide technical expertise as well as real world results.
It's been just under 3 months since i had a symfony put in my right eye. My left eye does not have a cataract and I wear a contact lens -2.0
My assessment so far:
1. distance vision is 20/20 or slightly better
2. reading vision (about 12 inches) 20/30
3. intermediate vision (about 18 inches+) is excellent.
4. no issues reading my phone, menus, newspaper, computer with one symfony lens and the other nearsighted eye corrected with a -2.00 contact lens.
Issues:
1. only one - night driving I see a fair amount of haze/starbursts around headlights of oncoming cars in certain driving conditions
My options for my 2nd eye are another symfony or a aspheric monofocal.
I just returned from a pre-surgical appointment for my 2nd eye. The doctor said there's a chance (actually a good chance) the 2nd eye would not have those visual artifacts and be perfectly fine with another symfony. He also stated neuroadaptation won't start until both eyes are corrected so even though it's been 3 months, the clear eye has not allowed my brain to adapt. That said - he thought a monofocal would be the least risky for me since I do drive a good deal at night. The 'worst' part of this decision, he said, is that I wouldn't have the benefit of two eyes using the symfony for near/intermediate vision and then may require readers in some situations. At this time even with just one eye using a symfony I don't require readers. I believe in the last 3 months I used them 2 or 3 times to read very tiny print in dim lighting.
The good news for others considering symfony- In the last 4 or 5 months the majority of his patients choosing multi-focals have gone with symfony and so far I'm the only one to report an issue with halos/glare. He did qualify that by saying that younger people tend to notice and be bothered by visual artifacts much more than older people, but most eventually adapt after 6 months.
In a few weeks I'll have the monofocal lens implanted and will report back how the vision quality is with this particular combination.
While you still have your natural lens in one eye, here is one issue I'd been curious about that I thought I'd mention in case you were curious to compare your eyes.
I'd been curious before about the issue that the Symfony corrects chromatic aberration compared to what the brain has been used to with the natural visual system. Chromatic aberration leads different wavelengths to require different lens powers to be in best focus, so I wasn't sure if there were any subtle depth perception cues this would throw off, but I hadn't noticed any. Since objects vary in color it makes sense that we wouldn't usually rely on it, but I wasn't sure if it'd alter our perceptions a bit still. I finally happened to lookup the term for the phenomenon I was curious about and found a wikipedia overview:
https://www.wikiwand.com/en/Chromostereopsis
"Chromostereopsis
Chromostereopsis is a visual illusion whereby the impression of depth is conveyed in two-dimensional color images, usually of red-blue or red-green colors, but can also be perceived with red-grey or blue-grey images.[1][2] Such illusions have been reported for over a century and have generally been attributed to some form of chromatic aberration."
The Symfony doesn't eliminate all chromatic aberration so I do see a difference in the sample images on that page (I hadn't searched for any better links on the topic or test images) though I don't know if it would differ from what I'd see without it.
Your input is invaluable regarding visual aberrations with the Symfony IOL. My cataract surgery for eye #1 is currently scheduled for 4/5 - one day ahead of your surgery for your second eye.
Hello Petey212:
It would appear that at 7 weeks post-op you are concerned about visual aberrations ("halos/glare")
induced by your Symfony eye. Moreover you are "still considering another Symfony, [or] a monofocal" IOL in your clear, second eye.
I just wondered if the neuro-adaptation concept that SoftwareDeveloper discussed is enhanced by bilateral Symfony IOLs versus the combination of one Symfony IOL and one monofocal IOL, or versus the combination of one Symfony IOL and a contact lens for the clear eye (your present situation).
In the latter case, I could only get some hints with my cataract surgery tentatively set in April with eye #1 to receive a Symfony IOL - followed two weeks later - by eye #2 also receiving a Symfony IOL. During that two-week interval, I will continue to wear a contact lens in eye #2. Perhaps adjustment to halos would more optimal if I had surgeries with Symfony IOLs in both eyes within ~24 hours, as did SoftwareDeveloper.
7 weeks post - OP update:
Daytime vision is fantastic, but night I still see halos and starburst around lights.
Last week I followed up with a retina specialist. He evaluated both eyes to assess the risk of Retinal Detachment. This was not something my original surgeon suggested, but a concern of mine before I resumed sports - specifically weight training and before I had my other eye (without a cataract) done.
The retina specialist stated I have a couple of risk factors for RD (including the surgery), but he would consider them minor. If I had a family history of RD that would have been a much bigger concern.
He informed me I have slight lattice degeneration which is a risk factor that gives someone a .5% chance of RD. He was not concerned about that (as he said it was slight) and said he would see no reason not to move forward with the second surgery. He did clarify that he would not recommend doing a clear lens exchange on both eyes, but since I had one already done, keeping both eyes in sync is a significant benefit as well as a safety concern.
As far as sports & weight training he said do anything I did before with the exception of boxing or anything that could result in a punch to the eye- basically the advice he'd give anyone - IOL or not. He said proper breathing during weight training should also be used to reduce unnecessary pressure.
I have an appointment with my cataract surgeon in three weeks for a pre-surgical evaluation. At this time I'm still considering another symfony, but also a monofocal (possibly even lasik) in my clear eye. I want good distance vision in both eyes, but I also want to reduce the chance of glare/halo in the second ey. As stated I do have halos in my symfony eye and I'm concerned if I have it in both it would significantly impact my night driving. Right now the good eye offsets the haze and concentric circles I see around lights and is not an issue. If I had it in both- it could be a problem.
Hi Petey212:
Thanks for your detailed experience so far with the Tecnis "Symphony" IOL in one eye. (And thanks as well to SoftwareDeveloper who is a kind of anchor on this forum.)
So far, you describe a very encouraging post-op experience!
I am now preparing for bilateral cataract surgery in April, and I wondered if the optical performance of your Symphony eye is still stable, and if your visual disturbances continue to recede?
I just had a follow up with doctor. 11 days post op distance vision in corrected eye is 20/20. He said it may improve a bit more, but intermediate and near is more likely to improve. Right now I'm very satisfied with intermediate vision which is 20/20 at computer distance. If near improves even more that would be fantastic.
When I asked about risk for Retinal Detachment in younger men he was not overly concerned. He said there is a risk factor, but incidents are much lower now than 1980s/early 90s and even better than just 10 - 15 years ago. My axial length is 26.2 - which he said is longer than average and another risk factor. He said although it ‘mathematically’ increases risk, realistically it's still very low.
That said I am going to postpone having the second eye done since at this time it is still 20/20 with a contact lens and unaffected by the very small cataract it has. He had no issue with that, but said it may take longer to neuro-adapt to the symfony. Next appointment is 1 month from now.
My observations so far:
Overall I’m extremely happy with the results. Being able to see very clearly out of this eye for the first time in several years is just amazing. I’m able to read sheet music, restaurant menus (with decent light), my iphone, and see the TV perfectly (about 14 feet from my couch). Everything from about 15 inches out is remarkably clear. All that while having excellent distance vision.
At this point I still see a slight haze around lights at night and depending on the type/color of light - Led, fluorescent, incandescent, etc. the haze is either not there at all, more prominent or I can sometimes slightly see the symfony’s concentric rings within the haze. All very subtle and not really distracting, but I can see it.
The doctor has not done many symfonys but based on reports and other multi-focals, he feels this haze will reduce over time. I certainly notice it’s getting better each day. Interesting point- last night while driving in heavy rain the haze around the lights was greatly reduced- almost non-existent. Perhaps the light passing through the rain droplets somehow diffused the haze to make it unnoticeable. I’ll have to check some of my physics books to determine the optics of that effect. The wet streets with the reflected street lights & headlights posed no issue at all with glare. I was expecting driving at night in the rain to be worse, but was pleasantly surprised. I have also driven in a minor snow storm and it was fine- if anything the symfony was better than the good eye.
My observations based on different lighting conditions:
Bright Daylight-
No difference between my good eye and symfony. Both see equally well. One exception- when looking into a wooded area in the distance the symfony eye tends to blend the subtle browns. The doctor feels the contrast sensitivity would improve with time and would likely be faster with symfony lenses in both eyes.
Overcast Days/ Dusk –
Symfony eye appears brighter and much crisper than my natural lens
Night –
On dark roads vision is excellent, however, to the symfony eye the shoulder or woods to the side of the road in my periphery appear darker. Freeways and city streets symfony is very good and I can read street signs, license plate, etc. without issue. Back lit street signs or store signs appear clearer in the symfony eye. The only issue at night is the aforementioned slight haze around lights
You were only a -2D myope, which is considered low myopia and isn't high enough to be considered a noticeable risk factor for retinal detachment. High myopia is usually considered to be -6D or more. Axial length long enough to be a risk factors of concern tends to go along with high myopia. Its useful to be aware that retinal detachment is possible, but the risk is fairly low.
FYI, in terms of Symfony results, I'm now 2 years +1 month postop and just had an eye check this week. I tested at least 20/15 at distance (they didn't show a line below that to see if it might be a bit better than that. I should have asked out of curiosity, that line was easy to read), and 20/20 at computer distance (plus a bit on the line below).
In the past I consistently tested 20/25 at my best near distance, but in this case they didn't have a line for that. They tested at 40 centimeters (rather than best near) and I was 20/30, though I saw some of the 20/20 line below that.
My near is aided by a very tiny bit of accidental myopia in my right eye that provides most of the near (making up for hyperopia in the other).
OD: -0.25D -0.25D X 127
OS: +0.5D (no astigmatism).
The right eye sees 20/15 at distance despite that tiny myopia, oddly the left eye can't read the 20/15 line. I neglected to find out what my best corrected distance vision would be, since I did see some improvement with the refraction.
In the past my right eye was 0D but with -0.5D of astigmatism, I don't know if it was a very slight shift or its just within the margin of measurement error with a different doctor doing the refraction using different equipment. I keep wondering about a laser teak for the hyperopic eye, but it hasn't been enough of an issue to bother looking into it, and not worth the expense for the moment.